Dynamic Contrast-Enhanced Ultrasound of Gastric Cancer: Correlation with Perfusion CT and Histopathology

OBJECTIVE: To assess the relationship between contrast-enhanced ultrasound (CEUS) parameters and perfusion CT (PCT) parameters of gastric cancers and their correlation with histologic features. MATERIALS AND METHODS: This prospective study was approved by our Institutional Review Board. We included 43 patients with pathologically-proven gastric cancers undergoing CEUS using SonoVue® (Bracco) and PCT on the same day. Correlation between the CEUS parameters (peak intensity [PI], area under the curve [AUC], rise time [RT] from 10% to 90% of PI, time to peak [TTPUS], and mean transit time [MTTUS]) and PCT parameters (blood flow, blood volume, TTPCT, MTTCT, and permeability surface product) of gastric cancers were analyzed using Spearman's rank correlation test. In cases of surgical resection, the CEUS and PCT parameters were compared according to histologic features using Mann-Whitney test. RESULTS: CEUS studies were of diagnostic quality in 88.4% (38/43) of patients. Among the CEUS parameters of gastric cancers, RT and TTPUS showed significant positive correlations with TTPCT (rho = 0.327 and 0.374, p = 0.045 and 0.021, respectively); PI and AUC were significantly higher in well-differentiated or moderately-differentiated tumors (n = 4) than poorly-differentiated tumors (n = 18) (p = 0.026 and 0.033, respectively), whereas MTTCT showed significant differences according to histologic types (poorly cohesive carcinoma [PCC] vs. non-PCC), T-staging (≤ T2 vs. ≥ T3), N-staging (N0 vs. N-positive), and epidermal growth factor receptor expression (≤ faint vs. ≥ moderate staining) (p values < 0.05). CONCLUSION: In patients with gastric cancers, CEUS is technically feasible for the quantification of tumor perfusion and may provide correlative and complementary information to that of PCT, which may allow prediction of histologic features.

Malignant Pleural Mesothelioma and Gastric Metastasis: A Very Rare Case Report and Literature Review.

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm. It has closed association with occupational asbestos exposure. Symptoms are commonly due to local invasion of pleura and mediastinal structures. MPM may have local or rarely distant organ metastasis by haematogenous spread in different organs such as liver, adrenal gland, kidney and contralateral lung. However, gastrointestinal involvement is very rare. Case Report: We report herein a 58-year-old female patient who was presented with back painand finally was diagnosed as MPM with distant metastasis to the stomach. Conclusion: Clinical, imaging and histopathologic findings play an important role in influencing the prognosis as well as treatment.

Esophageal Cancer Staging

Accurate staging of esophageal cancer is very important to achieving optimal treatment outcomes. The AJCC (American Joint Committee on Cancer) first published TNM esophageal cancer staging recommendations in the first edition of their staging manual in 1977. Thereafter, the staging of esophageal cancer was changed many times over the years. This article reviews the current status of staging of esophageal cancer.

The use of dynamic contrast enhanced MRI in differentiating between benign and malignant breast tumors and predicting the histologic grade for breast cancer patients / 中华放射学杂志

Objective To evaluate whether dynamic contrast enhanced-MRI (DCE-MRI) can help clinicians in differentiating malignant tumors from benign lesions and in predicting and correlating the histologic grade for breast cancer patients.Methods DCE-MRI from 98 patients (with histopathological confirmation) in our department were retrospectively analyzed.In the first dynamic phase,the hot and cold spot ROIs were selected as the regions with maximum and minimum Slopein,respectively.The kinetic characteristics (including hot spot,cold spot,and heterogeneous characteristics) and morphologic features were evaluated.The ROC curve analysis was used to test the diagnostic power of all DCE-MRI parameters (inflow slope,Slopein ; washout slope; inflow slope ratio; washout slope ratio; time-signal intensity curve shape; rim enhancement; internal homogeneity) for differentiating malignant tumors from benign breast lesions.Joncheere-Terpstra test was adopted to analyze the kinetic data.Categorical data were analyzed by using the Fisher test.Results Hot spot Slopein might have the biggest area (0.620) under the ROC curve (but not significant) among all the different MRI parameters(P ＞ 0.05).Its sensitivity,specificity,positive predictive value,negative predictive value were 63.2％ (55/87) and 72.7％ (8/11),respectively.The cold spot parameter Slopein(P =0.025),heterogeneity parameter ratio-in (P =0.031),and internal homogeneity (P =0.032) showed a significant correlation with histologic grade.The median and quartile of cold spot Slopein in pathologic Ⅰ,Ⅱ,and Ⅲ were 6.1 × 10-3,5.4 × 10-3 and 1.4 × 10-3,respectively;inflow slope ratio:6.6,9.8 and 17.6 ; pathologic Ⅰ,Ⅱ,and Ⅲ showed 2,1,and 0 patients with homogeneity enhancement,respectively ; intermediate enhancement:5,12,and 2 patients,respectively;heterogeneity enhancement:2,6,and 8 patients.Conclusions The DCE-MRI is a potential tool in helping clinicians to predict the histologic grading in breast cancers.Parameter hot spot Slopein might help differentiae malignant tumors from the benign counterpart.

Postoperative radiotherapy for ependymoma

PURPOSE: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. MATERIALS AND METHODS: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). RESULTS: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. CONCLUSION: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

Postoperative radiotherapy for ependymoma

PURPOSE: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. MATERIALS AND METHODS: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). RESULTS: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. CONCLUSION: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

Virus Genotype and Lamivudine Resistant Mutation in Chronic B-Viral Hepatitis and Correlation with Pathologic Findings / 대한진단검사의학회지

BACKGROUND: Despite significant progress in vaccine and therapeutic regimen, hepatitis B virus (HBV) infection remains one of the major diseases. Long-term use of lamivudine can induce the emergence of drug resistance. TRUGENE(TM) HBV Genotyping (Visible Genetics Inc., Ga, USA) is an assay that reports the viral genotype and mutations likely to confer resistance to antiviral therapy. In this study, we analyzed HBV genotype and mutations and correlated them with the histologic grade and stage of the liver disease to provide the useful information about the therapy of chronic liver disease. METHODS: HBV DNA was isolated from 86 patients with HBV-associated chronic liver diseases and analyzed by TRUGENE(TM) HBV Genotyping. Histologic grade and stage were correlated with RESULTS: HBV genotypes of 86 patients were all C (100%). Mutations associated with lamivudine resistance were detected in 10 patients (11.6%) and M204I (YIDD) mutant was the most common. Unknown mutation such as L180F was also detected. Statistical analysis showed that the number of coding changes at HBsAg region was significantly correlated with the lobular activity (P=0.01). CONCLUSIONS: All patients were genotype C and lamivudine resistant mutations were detected in 11.6%. L180F mutation, not known previously, was detected in one case. Number of coding changes at HBsAg region was significantly correlated with the lobular activity. It was considered that follow-up studies about the clinical significance of coding changes in HBsAg are needed, and that a further study such as in vitro transfection is necessary to confirm the possibility of a novel mutation of L180F.

Histologic Grading and Staging of Chronic Hepatitis: On the Basis of Standardized Guideline Proposed by the Korean Study Group for the Pathology of Digestive Diseases / 대한간학회지

No abstract available.

Clinicopathologic Significance of p53 and c-erbB-2 Protein Expression in Breast Carcinoma / 한국유방암학회지

PURPOSE: Reliable prognostic factors, including clinicopathological parameters (Ed-alternatively, "Reliable clinicopathologic prognostic factors") such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid receptor status, are necessary in the management of breast cancer for predicting clinical course and as guide lines for adjuvant therapy. Recently, many reports have shown that expression of p53 and c-erbB-2 products is associated with poor prognosis. To elucidate the clinical value of p53 and c-erbB-2 protein expression as prognostic factors, their immunoreactivities were compared with known clinicopathologic prognostic factors. METHODS: The expressions of p53 and c-erbB-2 proteins were analyzed by immunohistochemical method with formalin-fixed and paraffin-embedded tissue samples of 71 invasive breast carcinomas accumulated between 1996 and 1999 at Chungbuk National University Hospital. The expressions of p53 and c-erbB-2 proteins were compared with established prognostic factors such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid hormone receptor status. Statistical significance was analyzed by chi-square test. RESULTS: The immunoreactivities of p53 and c-erbB-2 proteins were detected in 29.6% and 46.5%, respectively, of the samples. p53 positivity was significantly higher in breast car-cinoma that showed higher histologic grade or was metastasized to more than 3 axillary lymph nodes (P<0.05). There were no significant correlations between c-erbB-2 positivity and known clinicopathologic prognostic factors. CONCLUSION: This study suggests that expression of p53 protein could be used as a prognostic indicator in the management of breast cancer. But the impact of p53 and c- erbB-2 protein expression on overall survival and disease free survival rates should be evaluated further before being used as independent prognostic factors.

Clinicopathologic Significance of p53 and c-erbB-2 Protein Expression in Breast Carcinoma

PURPOSE: Reliable prognostic factors, including clinicopathological parameters (Ed-alternatively, "Reliable clinicopathologic prognostic factors") such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid receptor status, are necessary in the management of breast cancer for predicting clinical course and as guide lines for adjuvant therapy. Recently, many reports have shown that expression of p53 and c-erbB-2 products is associated with poor prognosis. To elucidate the clinical value of p53 and c-erbB-2 protein expression as prognostic factors, their immunoreactivities were compared with known clinicopathologic prognostic factors. METHODS: The expressions of p53 and c-erbB-2 proteins were analyzed by immunohistochemical method with formalin-fixed and paraffin-embedded tissue samples of 71 invasive breast carcinomas accumulated between 1996 and 1999 at Chungbuk National University Hospital. The expressions of p53 and c-erbB-2 proteins were compared with established prognostic factors such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid hormone receptor status. Statistical significance was analyzed by chi-square test. RESULTS: The immunoreactivities of p53 and c-erbB-2 proteins were detected in 29.6% and 46.5%, respectively, of the samples. p53 positivity was significantly higher in breast carcinoma that showed higher histologic grade or was metastasized to more than 3 axillary lymph nodes (P<0.05). There were no significant correlations between c-erbB-2 positivity and known clinicopathologic prognostic factors. CONCLUSION: This study suggests that expression of p53 protein could be used as a prognostic indicator in the management of breast cancer. But the impact of p53 and c- erbB-2 protein expression on overall survival and disease free survival rates should be evaluated further before being used as independent prognostic factors.

Underestimate the histologic grade by biopsy preoperative in bladder urotheliai carcinoma / 中华泌尿外科杂志

Objective To compare the histologic grade between biopsy and postoperative specimen in bladder urothelial carcinoma,and approach the state and the reasons of underestimate the histologic grade preoperative.Methods We retrospectively 82 cases of urothelial carcinoma at the Third Affiliated Hospi- tal of the Sun Yat-Sen University.For all the cases in this study,the histologic grade,using the 1998 World Health Organization and International Society of Urological Pathologists(WHO/ISUP)classification,was i- dentical when the biopsy specimen and postoperative specimen were compared.Results In this study,35 cases,28 cases and 19 cases were G_1、G_2、G_3 by biopsy preoperative,respectively;while 22 cases,32 cases、28 cases were G_1、G_2、G_3 postoperative,respectively.There were 24 cases(29.3%)underestimate the histo- logic grade by biopsy preoperative in the 82 cases,while 4 cases(4.9%)overestimate preoperative.The state of underestimate the histologic grade is correlated with the location of biopsy,tissue dose and the conser- vation of pathology judgment.Conclusions There were 24 cases(29.3%)underestimate the histologic grade by biopsy preoperative.We should pay more attention to this state of underestimate the histologic grade preoperative in the treatment of bladder urothelial carcinoma.

p53 Expression and Ki-67 Labeling Index in Brain Tumor with Special Reference to Tumor and Histologic Grade

Mutation in the p53 suppressor gene is the most common genetic alteration found in human cancers including primary brain tumors. Ki-67 labeling index(LI) is known to be a marker of proliferating activity. The purpose of this study was to verify whether an immunohistochemical expression of p53 antibody and Ki-67 LI could be related to different clinicopathologic parameters including histologic grade, size, invasiveness and recurrence of the brain tumors. Materials were based on the 147 surgically resected brain tumors during the last two years. Of the 147 brain tumors, there were 35 astrocytic tumors, 35 meningiomas, 10 oligodendrogliomas, 7 craniopharyngiomas, 5 dysembryoplastic neuroepithelial tumors, 4 medulloblastomas, 5 ependymomas, 23 pituitary adenomas, 9 schwannomas, and 14 other brain tumors. The p53 expression and Ki-67 LI were higher in malignant brain tumors including astrocytic tumors, medulloblastoma, PNET and gliosarcoma. The p53 positivity was correlated with histologic grades and tumor recurrence. The brain tumors with a high Ki-67 LI(>6%) also showed a close relationship to a higher histologic grading, radiological invasiveness and recurrence. There was no evident correlation with the age and tumor size with p53 expression and Ki-67 LI. These results suggest that p53 overexpression and high proliferation potential of the tumor cells are associated with the higher histologic grade and aggressive clinical course in the central nervous system tumors.

Relationship between P53, Bcl-2, Apoptosis and Histologic Grade of Brain Tumors

We studied thirty benign and twenty-one malignant brain tumors in order to investigate the relationship between p53, bcl-2, apoptosis and histologic grade of brain tumors. For the study of p53 and bcl-2 gene expression, we used immunohistochemical staining method using monoclonal antibodies to p53 and bcl-2; and, for apoptosis, In-situ end labeling technique was used. The malignant group showed significantly higher p53 and apoptosis positive index(PI) than the benign group(mean p53 PI, malignant: 16.0 benign: 0.9/mean apoptosis PI, malignant: 2.3 benign: 0.2)(p=0.003); but bcl-2 positive index was not significantly different between two groups (p=0.118). Correlation between p53 mutation and apoptosis PI was statistically significant(p=0.012, Pearson coefficient=0.349); but correlation between bcl-2 expression and apoptosis PI was not(p=0.318). Moreover, correlation between p53 mutation and bcl-2 expression was not statistically significant(p=0.583). These results suggest that higher p53 mutation tends to exist in the group of tumors with higher malignant histologic grades. Furthermore, it can be concluded that greater DNA damage reflected by higher frequency of apoptosis tends to exist in the group of higher malignant histologic grade.

Flow Cytometric DNA Analysis of Gastrointestinal Stromal Tumors

To evaluate the correlation between the histologic grade and DNA ploidy or proliferation index/S phase fraction (SPF) of gastrointestinal stromal tumors, we performed the DNA analysis using the flow cytometry. Paraffin embedded tissue samples of 57 gastrointestinal stromal tumors were used. The sites of the tumors were: stomach (28), small intestine (23), and large intestine(6). DNA index, proliferative index, and SPF by the flow cytomery were compared with histologic grade. The histologic grade of the gastric tumors were benign (12), borderline (10), and malignant (6). Those of the small intestinal timors were benign (2), borderline (13), and malignant(8). The large intestine were borderline (2), and malignant (4). In stomach, aneuploidy was found in 25.0% of benign, 40.0% of borderline, and 100% of malignant. And there was statistically significant correlation between the histologic grade and ploidy (p < 0.05). By contrast, small and large intestinal tumors showed more frequent aneuploidy in benign than in malignant. The proliferative index was correlated with the histologic grade in gastric tumors (p<0.05), but the SPF was not. In conclusion, the ploidy and proliferative index of gastric tumors are closely correlated to the histologic grade. However, aneuploidy in tumors of the small and large intestine were difficult to predict the malignancy.

The Study of Expression of Proliferating Cell Nuclear Antigen(PCNA) and Nucleolar Organizer Regions(NORs) in Transitional Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

The expression of two cell proliferation indices, the proliferating cell nuclear antigen( PCNA), using the monoclonal antibody in the immunoperoxidase method, and the nucleolar organizer regions (NORs), using silver nitrate staining technique, were assessed in formalin-fixed paraffin embedded material of transitional cell urinary bladder carcinomas. The aim of our study was to examine comparatively the expression of PCNA and the number of NORs in 37 transitional cell bladder carcinomas and to investigate how they correlate with tumor grade and the disease stage. It was noticed that the PCNA expression rate(%) related to grade was statistically significant only between grades II and III (p 0.05). The mean number of AgNORs per nucleus between grades I and II and between grades II and III were statistically significant(p<0.05). As far as the correlation of PCNA expression rate(%) with the stage is concerned, PCNA expression rate (%) was higher in the invasive tumors(p<0.05) than in the superficial tumors and AgNOR Numbers was also greater in the invasive tumors(p <0.05). The linear correlation coefficient between PCNA expression rate (%) and AgNOR counts was 0.52(p <0.001) In conclusion, a considerable relationship was found between the histological grade and each of the two indices used. A good correlation was also demonstrated between each of PCNA expression rate(%) and AgNOR scores to the pathologic stage. Our results suggest that PCNA expressionrate( % ) and AgNOR scores may be prognostic induces in urinary bladder cancer.